Rotavirus disease and its vaccines

1. Update on
Rotavirus Vaccine
Dr. S.K.Verma
Consultant Pediatrician
Mannat Nursing Home Pvt.Ltd.
Sitamarhi

2.  Diarrhea is defined as passage of 3 or more
loose or watery stool in 24 hours.
 For practical purposes recent change in
consistency and character of stool and its water
content is important than number of stool
 Acute diarrhea – begins acutely and last for <
14 days
 Persistent diarrhea – an episode of diarrhea ,
presumed to be caused by infectious agents
that begins Acutely but is of longer duration >
14 days.
 Chronic diarrhea – recurrent or long lasting
diarrhea > 2-4 wks with insidious onset and
often due to non infectious causes.
 Dysentery – diarrhea with visible blood &
mucous and often associated with fever and

4. Common causative organisms
Rotavirus ( 48.1 %)
Vibrio cholera 01(16.4%)
Giardia (14.2 %)
EAEC (12 %)
Adenovirus(11.6 %)
Cryptosporidium(11%)
Campylobacter jejuni(9.3 %)
Shigella (8 %)
Ent. Histolytica(4 %)

5. What are the signs and
symptoms of rotavirus?
2
How is rotavirus spread?
3
Who is most at risk?4
What are rotavirus
prevention strategies?
5
What is rotavirus ?
1

6.  Rotavirus is the most common cause of diarrheal disease
among infant and young children
 It is double stranded RNA virus
 The name rotavirus comes from the wheel-like
appearance of the virus under the microscope
 Nearly every child in the world is infected with rotavirus
at least once by the age of 5
 Accounts for 1/3 of hospitalization for severe diarrhea in
infants and children
 Causes about 37 % of death of children from diarrhea
 Out of 8 types species, Rotavirus A is most common ( > 90
%) in human
 Infections primarily in cool and dry season

7. Burden Of Rotavirus Diarrhea in India
Acute Diarrhea is leading cause of morbidity
and mortality in children in developing
country.
- > 1,20,000 Death annually
- About 4,50,000 Hospitalization in a year
- 5 million clinic visit in a year
- 25 million diarrheal episodes in U5
children

8.  Three main symptoms of rotavirus infection:
◦ Fever - low grade
◦ Nausea & Vomiting
◦ Watery diarrhea
 Abdominal pain may also occur
 Diarrhea usually Extends from 4 to 8 days
 Dehydration is more common in RV than other causes and
Most common cause of death related to Rotavirus.
 First infection usually produces symptoms but subsequent
are are typically mild or asymptomatic.
 40 % Protection after a single infection and 75-88 % after
subsequent infections
 Age group- between 6 month to 2 years most severely
affected

9.  Infants after the age of
3 months to 2 yrs
◦ Low to no immunity
◦ Vulnerable to dehydration
 Older children if they are
immunocompromised
Baby
> 3 months
Riskofdisease
Immuno-
compromised
Children
Adults Older
people
Population

10. Virology- RV is double stranded RNA
Eight species ( A,B,C,D,E,F & G)
Human – A,B & C
Pig – E & H
Birds- D,F & G
Two serotypes:
1. G Serotypes ( G1,G2)
2. P Serotypes ( P8,P6 & P4)
Viral proteins ( VP)- called virion – 6 VP
VP1,VP2,VP3,VP4,VP6 and VP7
VP4 and VP7 involved in immunity to infection
Common Strain in India
1.G1P(8)- 24.7 %
2.G2P(4)- 23.4 %
3.G9P(8)- 8.5 %

11.  Rotavirus infection is highly contagious
 Rotavirus spread by fecal-oral route
◦ The primary mode of transmission of rotavirus is the passage of
the virus in stool to the mouth of another child
How does rotavirus spread?

12. Transmission
 By Faeco – oral route via contact with
contaminated hands, surface and objects
 Highly contagious
 More than 10 trillion infectious particles per
gram of infected person faeces.
 Fewer than 100 of these required to transmit
infection from one to another
 Stable in environment and survive between 9 – 19
days
 Sanitary measure adequate for eliminating
bacteria and parasites seems to be ineffective in
control of rotavirus. Reason why rotavirus
infection is similar in both high and low health
standard country.

13.  Confirmation of a diarrheal illness such as
rotavirus requires laboratory testing
 Specific diagnosis of rotavirus infection is
made by finding virus in stool by enzyme
immunoassay
 Electron microscopy and polymerase chain
reaction
Are used in research laboratory.

14. Principle of management - Diarrhea
 Assessment and correction of dehydration
 ORS
 IV fluid if necessary
 Zinc
 Probiotics-
Saccharomyces boulardii
lactobacillus rhamnosus GG
Prebiotics – Role not documented.
Oligosacharide and Inulin

20. What can be done to prevent rotavirus and
diarrheal disease?

21. Currently There are 3 rota virus vaccines:
◦ Rotarix
◦ RotaTeq
◦ Rotavac

22. Rotarix
- Monovalent RV1, live attenuated rotavirus
vaccine containing human rotavirus G1P(8) strain
- Prevention from GE caused by G1 and Non G1
Types(G3,G4 & G9)
- 2 Doses required.
- Viral shedding > 50 % after 1 st dose like natural
infection
- Replicates well in gut
- Provide cross protection against most other
serotypes.

24.  Monovalent,human, live attenuated vaccine
containing one rotavirus strain G1P(8)
 Prevent infection from G1 and non- G1 types
(G3,G4 and G9)
 2 doses required
 1 st dose at 6 wks with DTP1
 2 nd dose at least 4 wks apart
 Ensure protection prior to natural infection
 Viral shedding > 50 % after first dose like natural
infection
 Cross protection against other
serotypes(G1P8,G3P8,G4P8,G9P8,G2P4
 Vaccine strain replicates well in gut

26. RotaTeq
 Human – bovine rotavirus vaccine
 Pentavalent ,RV5
 Contains 5 rotavirus strains produced by
reassortment between bovine and human
WC3 rotavirus containing VP7,VP4 &
G6proteins
 3 doses required
 Viral shedding is less as comparison to RV5
 Not broadly cross protective
 Grow less well in gut with comparison RV5

27.  Two natural rotavirus confer virtually 100 %
protection against mod/ severe disease
 1 st infection – 87%
 2 nd infection- 100 %
 A realistic goal for a rotavirus vaccine is to
establish the degree of protection against
disease that follows natural infection.
 The human G1P(8) strains in Rotarix mimics
natural rotavirus infection

28.  G1P(8) Strain increasingly predominant strain
in India
 From 29.5 % ( 2005-09) to 62.7 % (2012-14 )
seen in Expanded national rotavirus
surveillance network ( ENRSN)

30.  G 1P8 Strain vaccine – higher vaccine efficacy
( 85-98 %) against severe rotavirus
gastroenteritis in 1 st year of life in trials
conducted .
 Europe-95.8 %
 Latin America- 84.7 %
 Asia-100 %
 RVGE hospitalization start in 12 wks in India
and it warrants the need for early protection.

34. Rotavac
 Monovalent , live attenuated,
 Contains G9P(11) Human strains
 3 doses
 4 wks apart
 Begins at 6 wks

35. Dose Of RV
RVI- 2 doses ( 1 ml)
RV5- 3 doses ( 2 ml)
At 4 wks apart at 6 – 14 wks.
maximum age for 1 st dose < 15 wks
final dose < 8 months ( 32 wks)
S/E- Fever, vomiting, irritability, rash
A/E- Intussusceptions – rare
C/I- Past H/o of intussusceptions & severe
immunodeficiency
Precaution- Postpone during ongoing
diarrhea.

36.  Efficacy of Rotavirus vaccine in India
Protection Rate
Rotarix -
severe GE admission-42 %
Severe RVGE-85%
RotaTeq
RVGE of any severity- 74%
Severe RVGE-98%

37. Thank you
for your attention!